Gloria J. Morris

Differences in breast carcinoma characteristics in newly diagnosed African-American and Caucasian patients: a single-institution compilation compared with the National Cancer Institute's Surveillance, Epidemiology, and End Results database.

Breast carcinomas in African–American patients appear to be more aggressive than in Caucasian patients due to multifactorial differences.

Higher incidence of aggressive breast cancers in African-American women: a review.

Despite a lower incidence of breast cancers in African Americans than in Caucasians, mortality rates from breast cancer are higher in African Americans. This review summarizes disparate characteristics of breast cancer diagnosed in African Americans as compared with Caucasians, such as more advanced stage at diagnosis and less estrogen-receptor positivity of disease, in an effort to explain differences in their survival outcomes. Multifactorial explanations are offered, including differences in access to care, disparate utilization of mammography screening and often differences in treatment course-as well as biologic factors, such as higher incidence of aggressive breast cancer phenotypes, higher grade of tumor and higher growth index of tumors in African Americans as compared with Caucasians. Multiple population-based studies have been reviewed and screening and treatment interventions proposed in order to heighten awareness of these differences and to improve disease outcomes among this high-risk population.

Variants of uncertain significance in breast cancer-related genes: real-world implications for a clinical conundrum. Part one: clinical genetics recommendations.

At times we encounter clinical prob-lems for which there are no directly ap-plicable evidence-based solutions, butwe are compelled by circumstances toact. When doing so we rely on relatedevidence, general principles of bestmedical practice, and our experience.Each “Current Clinical Practice” featurearticle in

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma With Pancytopenia and Chylothorax

t r n c s p o c C C f e m t t p c S m p t r v o 7 a t p c a t e M o m b T n C m i ( t l o p At times we encounter clinical problems for which there are no directly applicable evidence-based solutions, but we are compelled by circumstances to act. When doing so we rely on related evidence, general principles of best medical practice, and our experience. Each ”Current Clinical Practice” feature article in Seminars in Oncology describes such a challenging presentation and offers treatment approaches from selected specialists. We invite readers’ comments and questions, which, with your approval, will be published in subsequent issues of the Journal. It is hoped that sharing our views and experiences will better inform our management decisions when we next encounter similar challenging patients. Please send your comments on the articles, your challenging cases, and your treatment successes to me at Gloria. Morris@hemonc1.com. I look forward to a lively discussion.

A 75-Year-Old Woman With Thoracic Spinal Cord Compression and Chloroma (granulocytic sarcoma)

Acute Myeloid Leukemia (AML) in adults is an often heterogeneous disease entity in its etiology and presentation, but recent advances have certainly shown that effective treatments may result in complete remission at substantial rates (1). According to American Cancer Society statistics (2), 12,330 people were diagnosed with AML in 2010, with 8,950 deaths from the disease, and an estimated 12,950 new cases and 9,050 deaths in 2011 (3). As indicated by these approximations, the incidence of AML appears to be rising, likely due to the increasing age of the population, with etiologies in the elderly more likely to include AML arising in a background of myelodysplasia, related to chemical exposures, or related to treatment for other previous cancers (1). A “typical” presentation of AML may present with sequelae of cytopenias, including bleeding and petechial rashes, infection, fatigue and weakness, weight loss and systemic symptoms. However, there are interesting unusual presentations of AML that may manifest with alarming clinical findings. These can include pericardial and pleural effusions (4a-Rege K et al), as well as rare cases of atrial involvement (5b- Tirado et al). CNS infiltration (6c-Schumann et al) has also been reported and is more likely in monocytic-lineage leukemias that may favor sanctuary sites (1), and these leukemias may also present with gum and soft tissue infiltration (7a). Neurologic complications have indeed been seen and reported in the literature as far back as the 1960’s and 1970’s with descriptions of meningitis, encephalitis, hemi- or paraplegias, involvement of cranial or peripheral nerves, and spinal cord compression (7d- Anjaria et al). Even more specifically, however, leukemias giving rise to spinal cord involvement due to vertebral destruction or epidural masses have been reported in the literature by Wildydes in 1963, and summarized by Anjaria. Myeloid sarcoma arises as a subacute form of AML, with a male:female ratio of 2:1, increased incidence in children or young adults, and presentation as a single or multiple tumor masses made up of immature leukemic cells with or without green pigments, and located in the subperiosteum or bone marrow. It can appear in the orbit, anywhere in the skull, sinuses, spine, sacrum, or ribs, with radiologic features of local erosion, cortical thinning, compression at extradural or peripheral nerves sites, but not necessarily causing invasion of the dura (7d-Anjaria et al, referencing 8e-Aita 1964, 9f- Rao 1962). We report here the presentation of AML as a “surprise” finding in an elderly female with virtually no obvious peripheral pancytopenias or abnormalities of her complete blood count, but who presented with an acute spinal cord compression and bony destruction in the spine. In particular, this patient’s leukemia cells also exhibited a t(9;22) translocation in addition to an unusual FAB classification of AML with megakaryocytic differentiation as the phenotype. We ask the following questions: (a) What treatment options would you offer this patient? Is she a candidate for aggressive induction chemotherapy? Biological therapy? (b) How would you monitor her for response to treatment? (c) How would you recommend and tailor maintenance therapy for this individual?

A Wealth of New Options: A Case Presentation of the Management of Castration-Recurrent Prostate Cancer

a t f t p p t At times we encounter clinical problems for which there are no directly applicable evidence-based solutions, but we are compelled by circumstances to act. When doing so we rely on related evidence, general principles of best medical practice, and our experience. Each ”Current Clinical Practice” feature article in Seminars in Oncology describes such a challenging presentation and offers treatment approaches from selected specialists. We invite readers’ comments and questions, which, with your approval, will be published in subsequent issues of the Journal. It is hoped that sharing our views and experiences will better inform our management decisions when we next encounter similar challenging patients. Please send your comments on the articles, your challenging cases, and your treatment successes to me at Dr.gjmorris@gmail.com. I look forward to a lively discussion.

Mucinous Colloid Carcinoma of the Colon Metastatic to the Breast

P6–04-08 4. Adsay NV, Merati K, Nassar H, et al. Pathogenesis of colloid (pure mucinous) carcinoma of exocrine organs: coupling of gel-forming mucin (MUC2) production with altered cell polarity and abnormal cell-stroma interaction may be the key factor in the morphogenesis and indolent behavior of colloid carcinoma in the breast and pancreas. Am J Surg Pathol. 2003;27:

Residual disease after neoadjuvant chemotherapy for breast cancer.

Locally advanced breast cancer is a clinical quandary for which there is no standard treatment regimen. Often, preoperative chemotherapy regimens are chosen from proven regimens recommended for the adjuvant setting, as accepted by national panels. There are several accepted characteristics of breast tumors that may predict greater response to neoadjuvant chemotherapy, including phenotype, nuclear grade, and proliferation index. The following cases illustrate two clinical situations in which the neoadjuvant chemotherapy given yielded partial to near complete responses, yet left questions for the clinician regarding the optimum approach to best reduce the risk of recurrence.

Completely Regressed Cutaneous Melanocytic Lesion: Was It Benign or Was It Malignant?

c i W c m o d a At times we encounter clinical problems for which there are no directly applicable evidence-based solutions, but we are compelled by circumstances to act. When doing so we rely on related evidence, general principles of best medical practice, and our experience. Each ”Current Clinical Practice” feature article in Seminars in Oncology describes such a challenging presentation and offers treatment approaches from selected specialists. We invite readers’ comments and questions, which, with your approval, will be published in subsequent issues of the Journal. It is hoped that sharing our views and experiences will better inform our management decisions when we next encounter similar challenging patients. Please send your comments on the articles, your challenging cases, and your treatment successes to me at Gloria.Morris@hemonc1.com. I look forward to a lively discussion.

55-Year-Old Woman With Estrogen Receptor-Positive Scalp Lesion

At times we encounter clinical problems for which there are no directly applicable evidence-based solutions, but we are compelled by circumstances to act. When doing so we rely on related evidence, general principles of best medical practice, and our experience. Each “Current Clinical Practice” feature article in Seminars in Oncology describes such a challenging presentation and offers treatment approaches from selected specialists. We invite readers’ comments and questions, which, with your approval, will be published in subsequent issues of the Journal. It is hoped that sharing our views and experiences will better inform our management decisions when we next encounter similar challenging patients. Please send your comments on the articles, your challenging cases, and your treatment successes to me at dr.gjmor ris@gmail.com. I look forward to a lively discussion. Gloria J. Morris, MD, PhD Current Clinical Practice Feature Editor